MP warns that Canadians blind to dangers of prescription drugs

Canadians are willfully blind to the lethal risks of prescription drugs, which kill people “every day” through side effects, even at proper doses, according to a Conservative MP.

“All drugs are poisons,” Terence Young told a packed audience this week at the Art Gallery of Ontario in Toronto. “The only difference between a drug and a poison is dosage.”

By suppressing data about risk, clogging Parliament Hill with lobbyists, and bribing doctors with lunches and gifts, drug companies have conspired to keep blockbuster drugs on the market long after their dangers were known, he said. Enabled by Health Canada’s stagnant bureaucracy, and hushed up by coroners who do little but side with doctors, he said Big Pharma has “completely perverted” Canada’s drug safety monitoring regime.

“People just don’t want to believe,” said Mr. Young, who represents Oakville, a Toronto suburb. “People can’t handle the truth that their doctor would give them something that could kill them, or their daughter or son or mother. They can’t. It’s willful blindness.”

Activism against Big Pharma is a broad field. It runs a spectrum from informed skepticism to kooky theories about mind control and killer pills, all of which cropped up at the AGO event, sponsored by the Patients’ Association of Canada. It encompasses politicians who have forced drug companies to pay huge fines for false marketing, and fringe academics who believe nefarious doctors use drugs to control unusual people, keeping them weak and compliant under the medical gaze.

Few have the credibility — both personal and through his elected office — of Mr. Young, whose activism was inspired by the death in 2000 of his 15-year-old daughter Vanessa, who suffered a severe reaction to a nausea drug, leading to a lawsuit that is now settled.

But as he joins the social media campaign behind a new grassroots online database of adverse drug reactions called RxISK.org, critics worry that this singularity of purpose might exaggerate the dangers. By promoting anecdotes from self-selected, voluntary participants, RxISK.org might conjure an undue fear of drugs, they say, or deter sick people from care, or indulge the hypochondriac’s desire for horror stories.

Mental illness presents a special risk in this context, because paranoia frequently threatens the doctor-patient relationship, and such a skewed picture could cause sick people to stop taking their medicine, according to the Mental Health and Anti-Stigma research chair at Queen’s University.

“The general population would never think twice about taking a cancer drug with significant side effects in order to address their illness, but they’re very suspicious of psychotropic medication,” she said. “This is part of the stigma around mental illness and psychiatric treatment. Even many very learned people will say, ‘If I had a psychiatric illness, I would not take a psychiatric drug. I think they’re mind altering, they take your personality away.’ They wouldn’t do it.”

Sholom Glouberman, president of the Patients’ Association of Canada, spoke alongside Mr. Young and sketched the history of modern medicine since the end of the 19th century, showing how it began with insights into acute infectious diseases, each with an identifiable cause and a cure or vaccine.

Things changed, though. Now people live longer and rarely die from acute infectious diseases. Now it is chronic diseases that are the main focus of health care and cause the vast majority of disease deaths.

“The group that understands this shift better than any other is the drug companies,” Dr. Glouberman said.

David Healy, CEO of RxISK.org, is an Irish doctor working in Wales who has made a career of holding drug companies to account on these questions. He said the database, which launched in October, will eventually provide data that will prod regulators into action. In a broader sense, though, he said a key goal of RxISK.org is to drive doctors and patients away from a “magical” view of pills.

“A drug is made of a chemical and information. The chemical may be more or less good. It is a poison that depending on the dose may do good or harm. The key component to a drug, and the bit that’s potentially getting worse at the moment, is the informational part of the drug,” Dr. Healy said. “The magic used to lie in the doctor, and it’s moved into the pill. We’ve got to restore the situation where the magic lies in a doctor and a patient working as a team, and the pill is an aid that may help that.”

Though unique as a social media effort, RxISK.org is not filling a void. Health Canada operates a similar surveillance regime called the Vigilance Program, and a searchable database of reports. There is a similar program at the independent Institute for Safe Medication Practices Canada.

Mark Ferdinand, senior director, health and economic policy for Rx&D, Canada’s Research Based Pharmaceutical Companies, said there is “room for improvement in terms of the use of plain language” on drug labels, but otherwise, Canada has one of the most rigorous surveillance systems in the world.

‘People can’t handle the truth that their doctor would give them something that could kill them, or their daughter or son or mother’

He called RxISK.org “just yet another source of information that would need to be weighed and then analyzed in light of all the information that’s collected on medication incidents and adverse events.”

“Once you see all these signals, what scientists have to do is determine what weight to provide to the information. They have to also determine what is the quality of the information that has been provided, so for example if an individual simply says they had this type of reaction after having this drug, and that’s all they say, that may not be enough for a regulator or a scientist within industry to determine if there is a connection between the reaction and the drug itself. It may be something else in their daily life that could be causing the problem,” said Mr. Ferdinand.

This is the causality question, which is especially troublesome in medicine. Correlations are easily found, but proving causality is among the hardest things to do in science. Mr. Young even said coroners instruct their juries not to find drugs to be the cause of deaths after drug reactions, but rather just a factor.

“I don’t have any confidence in coroners,” he said, mocking their motto that they “speak for the dead to protect the living.”

“I think they speak for the doctors to protect the doctors,” he said.

These topics have always been controversial, and RxISK.org is no exception.

The emcee of the AGO lecture and RxISK.org’s spokesman, for example, David Carmichael, is a former director of ParticipACTION who drugged and suffocated his own 11-year-old son to death in a hotel room after a period of self-medication with Paxil, an anti-depressant. He was found not criminally responsible and treated in a secure hospital.

‘The magic used to lie in the doctor, and it’s moved into the pill’

Dr. Healy, for his part, was at the centre of one of Canada’s biggest academic freedom scandals, after his job offer at Toronto’s Centre for Addiction and Mental Health (CAMH), with a cross-appointment to the University of Toronto, was rescinded because he gave a lecture — described by CAMH at the time as unbalanced — warning of the suicide risk with Prozac, which was developed by Eli Lilly, a major donor to CAMH.

A lawsuit was settled out of court, and three years later, with Eli Lilly’s patent expired, Health Canada issued a warning about suicide risk, which today is widely known.

Mr. Carmichael offered several indicators that RxISK.org is off to a strong start. For example, it is now the number one Google result for the search “report prescription drug side effects” (number two is oprah.com, three is Health Canada, four is the U.S. Food and Drug Administration).

RxISK.org has seen 20,000 visitors a month, and now claims more patient reports than national regulators in Ireland and Germany. In the last two months of 2012, there were 58 reports from the U.S., 24 from the U.K., 20 from Canada, and others from New Zealand, Ireland, Australia and Germany.

“I remain optimistic because I have to be, because I’m so resolved to make change,” said Mr. Young.